Risk of wheezing and asthma exacerbation in children treated with paracetamol versus ibuprofen: a systematic review and meta-analysis of randomised controlled trials

Background Paracetamol and ibuprofen are the most commonly used medications for fever and pain management in children. While the efficacy appears similar with both drugs, there are contradictory findings related to adverse events. In particular, incidence of wheezing and asthma among children taking paracetamol compared to ibuprofen, remain unsettled. Methods We conducted a meta-analysis of randomized controlled trials (RCTs) that compared wheezing and asthma exacerbations in children taking paracetamol versus ibuprofen. A comprehensive search was conducted in five databases. RCTs reporting on cases of wheezing or asthma exacerbations in infants or children after the administration of paracetamol or ibuprofen were included. The pooled effect size was estimated using the Peto’s odds ratio. Results Five RCTs with 85,095 children were included in the analysis. The pooled estimate (OR 1.05; 95%CI 0.76–1.46) revealed no difference in the odds of developing asthma or presenting an exacerbation of asthma in children who received paracetamol compared to ibuprofen. When the analysis was restricted to RCTs that examined the incidence of asthma exacerbation or wheezing, the pooled estimate remained similar (OR 1.01; 95%CI 0.63–1.64). Additional bias adjusted quality effect sensitivity model yielded similar results (RR 1.03; 95%CI 0.84–1.28). Conclusion Although, Ibuprofen and paracetamol appear to have similar tolerance and safety profiles in terms of incidence of asthma exacerbations in children, we suggest high quality trials with clear definition of asthma outcomes after receiving ibuprofen or paracetamol at varying doses with longer follow-up are warranted for any conclusive findingThe publication of this article was funded by the Qatar National Library. The funding body had no role in study design, data collection, data analysis, data interpretation or writing of the manuscript

Enhancing Medication Safety through implementing the Qatar Tool for Reducing Inappropriate Medication (QTRIM) in Ambulatory Older Adults

Acknowledgments We appreciate: all Rumailah Hospital OPD supervisors and staff applying the manual tool, May Abusafa, Rasha Alqatami, Asma Gabkalla, Ahmed. Karawia, Mohamed Magdy, Tresita Jabonette, and all the pharmacy team; the geriatric mental and medicine department team who were involved in reviewing, supporting, and approving the tool, Hanadi Alhamad, Mahmoud Alrefaee, Irfan Muneeb, Marwan Ramadan, Zerak, Ahmed Almohamed; Nasser Masoudi and Abdulrazaq for supporting the project.Peer reviewe

Tobacco cessation programs and factors associated with their effectiveness in the Middle East: A systematic review.

In Middle East countries, the average prevalence of tobacco use is relatively high. This systematic review aimed to explore different tobacco cessation programs provided in the Middle East, identify healthcare professionals providing these programs, and the factors associated with their effectiveness. A systematic review was conducted using an electronic search of PubMed, EMBASE, Cochrane Library, ProQuest, and Web of Science, bibliographic databases between 24 January 2021 and 7 March 2021, to identify all relevant studies. The keywords used were 'tobacco cessation' and 'Middle East'. The review was undertaken applying the Preferred Reporting Items for Systematic Reviews and Meta-Analysis guidelines (PRISMA). Based on the study types, several quality assessment tools including the Cochrane risk of bias tool for randomized controlled trials, MINORS for quasi-experimental studies, NIH for cross-sectional studies, NIH for pre-post studies, and CASP for cohort studies, were used. Among the 512 studies screened, only 30 were included in this review. Our systematic review identified different cessation methods, with some employing both behavioral change and pharmacological methods, and some utilizing only one method. Physicians are believed to be the most common providers of cessation programs, with only a few other healthcare professionals doing so. The results of this review revealed that several factors are associated with the effectiveness of tobacco cessation programs in the Middle East including individual, interpersonal, community, organizational, policy, and environmental. Future research should focus on examining the sociocultural and economic factors that might influence tobacco cessation programs. The included studies were of average to poor quality, highlighting the need to conduct highquality studies. The findings provide evidence to encourage the development of multilevel programs to improve the efficacy of tobacco cessation initiatives in the Middle East

Factors Influencing Public Attitudes towards COVID-19 Vaccination: A Scoping Review Informed by the Socio-Ecological Model

Major hindrances to getting a COVID-19 vaccine include vaccine hesitancy, skepticism, refusal, and anti-vaccine movements. Several studies have been conducted on attitudes of the public towards COVID-19 vaccines and the potential influencing factors. The purpose of this scoping review is to summarize the data available on the various factors influencing public attitudes towards COVID-19 vaccination. This scoping review was conducted according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for Scoping Reviews (PRISMA-ScR) Statement. PubMed, Embase, Web of Science, and Cochrane Central were searched without restrictions to reclaim all publications on the factors that shape individuals’ attitudes towards COVID19 vaccines from 1 January 2020 to 15 February 2021. Fifty studies were included. The scoping review revealed that the factors influencing public attitudes towards COVID-19 vaccines were embedded within the different levels of the socio-ecological model. These factors included the sociodemographic characteristics of the individuals, individual factors, social and organizational factors. In addition, certain characteristics of COVID-19 vaccines themselves influenced public attitudes towards accepting the vaccines. Understanding various population needs and the factors shaping public attitudes towards the vaccines would support planning for evidence-based multilevel interventions in order to enhance global vaccine uptake

Risk of wheezing and asthma exacerbation in children treated with paracetamol versus ibuprofen: a systematic review and meta-analysis of randomised controlled trials

Background Paracetamol and ibuprofen are the most commonly used medications for fever and pain management in children. While the efficacy appears similar with both drugs, there are contradictory findings related to adverse events. In particular, incidence of wheezing and asthma among children taking paracetamol compared to ibuprofen, remain unsettled. Methods We conducted a meta-analysis of randomized controlled trials (RCTs) that compared wheezing and asthma exacerbations in children taking paracetamol versus ibuprofen. A comprehensive search was conducted in five databases. RCTs reporting on cases of wheezing or asthma exacerbations in infants or children after the administration of paracetamol or ibuprofen were included. The pooled effect size was estimated using the Peto’s odds ratio. Results Five RCTs with 85,095 children were included in the analysis. The pooled estimate (OR 1.05; 95%CI 0.76–1.46) revealed no difference in the odds of developing asthma or presenting an exacerbation of asthma in children who received paracetamol compared to ibuprofen. When the analysis was restricted to RCTs that examined the incidence of asthma exacerbation or wheezing, the pooled estimate remained similar (OR 1.01; 95%CI 0.63–1.64). Additional bias adjusted quality effect sensitivity model yielded similar results (RR 1.03; 95%CI 0.84–1.28). Conclusion Although, Ibuprofen and paracetamol appear to have similar tolerance and safety profiles in terms of incidence of asthma exacerbations in children, we suggest high quality trials with clear definition of asthma outcomes after receiving ibuprofen or paracetamol at varying doses with longer follow-up are warranted for any conclusive finding.Other Information Published in: BMC Pulmonary Medicine License: http://creativecommons.org/licenses/by/4.0/See article on publisher's website: http://dx.doi.org/10.1186/s12890-020-1102-5</p

Warfarin-Rifampin-Gene (WARIF-G) Interaction: A Retrospective, Genetic, Case–Control Study

Warfarin is extensively metabolized by cytochrome P450 2C9 (CYP2C9). Concomitant use with the potent CYP2C9 inducer, rifampin, requires close monitoring and dosage adjustments. Although, in theory, warfarin dose increase should overcome this interaction, most reported cases over the last 50 years have not responded even to high warfarin doses, but some have responded to modest doses. To investigate the genetic polymorphisms' impact on this unexplained interpatient variability, we performed genotyping of CYP2C9, VKORC1, and CYP4F2 for warfarin and rifampin concomitant receivers from 2016 to 2022 at Hamad Medical Corporation, Doha, Qatar. We identified and included 36 patients: 22 responders and 14 nonresponders. Warfarin-responders were significantly more likely to have one or more warfarin-sensitizing CYP2C9/VKORC1 alleles than nonresponders (odds ratio = 23.2, 95% confidence interval = 3.2–195.6; P = 0.0001). The mean genetic-based pre-interaction calculated dose was significantly lower for responders than for nonresponders (P < 0.001); and was negatively correlated with warfarin sensitivity index (WSI) (r = −0.58; P = 0.0002). The median percentage time in therapeutic range and mean WSI were significantly higher in the warfarin-sensitizing CYP2C9/VKORC1 alleles carriers than noncarriers (P = 0.017 and 0.0004, respectively). Whereas the warfarin-sensitizing CYP2C9/VKORC1 genotypes were associated with modest on-rifampin warfarin dose requirements, the noncarriers would have required more than double these doses to respond. Warfarin-sensitizing CYP2C9/VKORC1 genotypes and low genetic-based warfarin calculated doses were associated with higher warfarin sensitivity and better anticoagulation quality in patients receiving rifampin concomitantly.The cost for the materials and the genetic testing procedures was provided by Hamad Medical Corporation (HMC) to Qatar University (QU) as per a reimbursement Research Collaboration Agreement. The publication of this article was funded by Qatar National Library (QNL)